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Q&A

Intrapartum Fetal Assessment

Poster Session 2

(497) Fetal Heart Tracing Changes at Peak Methadone or Buprenorphine Dose Appear Unrelated to NOWS Severity

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective:

Medications for opioid use disorder (MOUD) are recommended, however prenatal predictors of Neonatal Opioid Withdrawal Syndrome (NOWS) remain poorly understood, creating distress for patients and providers.  Studies suggest buprenorphine and methadone  reduce fetal heart tracing (FHT) variability and accelerations, although not all fetuses exhibit this effect. We sought to determine if the presence of this effect is associated with NOWS.

Study Design:

We evaluated a retrospective cohort of term singleton pregnancies with MOUD administration at the time of labor and delivery at an academic urban hospital from 2016-2023. MOUD dose, dosing time, psychotropic medications, and non-prescribed substance exposures were obtained via chart review.  Clinically documented FHT variability and accelerations were collected at pharmacological trough and peak levels. FHTs with greater than 45 minutes of minimal variability during the peak period were characterized as minimal, and those without accelerations for more than 1 hour were characterized as absent. Differences in NOWS treatment were compared between the group with minimal variability and absent accelerations and the group without these features.

Results:

Seventy-seven dyads met inclusion criteria, and 38 neonates (49%) received pharmacotherapy for NOWS. Fifteen (19%) had FHTs with minimal variability and 43 (56%) had absent accelerations. While methadone was associated with minimal variability in FHT, there was no significant difference in the need for NOWS pharmacotherapy, use of a second agent, higher level of treatment, length of stay, or need for discharge home with medications for NOWS between groups.

Conclusion:

FHT changes at peak methadone or buprenorphine dose appear to have limited clinical utility in predicting the severity of NOWS.  Larger studies are needed to better elucidate prenatal risk factors to improve the counseling of birthing persons receiving treatment for OUD.